Management and Prevention
The previous article dealt with the causes and consequences of being overweight. Part 2 describes that although health problems related to weight are increasing worldwide, it is possible to reverse and prevent these difficulties by controlling diet and exercising…
Obesity and overweight are conditions in which weight gain (predominantly fat) has reached the point of endangering health. The prevalence of overweight and obesity has increased rapidly over the past two decades in the developed world and it has been described by the World Health Organization as ‘a global epidemic’ (WHO, 1998).
Obese people are more likely to suffer from a number of serious diseases, many of which are life limiting. Besides the physical effects, there are also considerable emotional and social effects. Weight loss in overweight and obese individuals improves physical and emotional health, often dramatically, and may also reduce obesity-related deaths.
To achieve weight loss and maintenance, lifelong sustainable changes in diet, physical activity, healthy lifestyle and behaviour are necessary.
THE SCIENCE BEHIND WEIGHT LOSS
The science behind being overweight comes down to a matter of energy balance. Excess fat is stored when people take in more energy (through food and drink) than they are using up in physical activity.
Our current environment means that it is easier to gain weight than it used to be. We have access to cheap, processed foods that are high in calories and we tend to do less physical activity in our daily lives. This has led to increasing numbers of people becoming overweight.
The best way to treat obesity is to reduce the amount of calories in the diet and to exercise more. The type of diet and exercise which is safe and will bring benefit varies from person to person. Any significant changes to lifestyle should be made only under medical supervision.
If we can reduce the number of calories that we take in, and increase our levels of physical activity, we can shift the energy balance back in favour of a healthy weight.
All weight loss programmes aim to shift the energy balance so that the energy going in is less than the energy going out. We can do this by:
- Changing the types and amount of food and drink we consume, e.g., swapping a glass of fruit juice to water will save about 200 calories per day.
- Increasing the amount of energy we use up, e.g., for a man or woman weighing 90kg, walking 30 minutes will use about 235 calories.
However, doing both at the same time is the best way to lose weight and keep it off for good. In general, most women will lose weight if they take food and liquids having 1,200 to 1,500 calories per day. Most men will lose weight if they take in between 1,500 and 1,800 calories per day.
The best way to lose weight is slowly. A weight loss of 1 to 2 pounds a week is possible, safe, and will help keep the weight off. It will also allow time to make new, healthy lifestyle changes.
To lose 1 to 2 pounds a week, obese adults should cut back their calorie intake by 500 to 1,000 calories a day.
Very low-calorie diets with fewer than 800 calories a day shouldn’t be used without medical supervision.
Healthy Eating Plan
A healthy eating plan gives your body the nutrients it needs every day. It has enough calories for good health, but not so many that you gain weight. A healthy diet should contain:
- meals based on starchy, high-fibre carbohydrates, such as wholegrain bread, pasta and rice
- at least five portions of fruit and vegetables every day
- a moderate amount of low-fat protein, milk and dairy products
- a very small amount of foods that are high in fat, sugar or salt
Foods to Limit
Foods that are high in saturated fats raise blood cholesterol levels and should be reduced or avoided. (Try and increase foods with unsaturated fats which will help keep your cholesterol levels down.)
Foods and drinks with added sugars give extra calories without nutrients like vitamins and minerals.
A portion is the amount of food that you choose to eat for a meal or snack. It’s different from a serving, which is a measured amount of food and is noted on the Nutrition Facts label on food packages.
Cutting back on portion size helps reduce calorie intake.
Studies show that people tend to eat a constant ‘weight’ of food. Knowing this, you can lose weight if you eat foods that are lower in calories and fat for a given amount of food.
For example, replacing a full-fat food product that weighs 2 ounces with a low-fat product that weighs the same helps you cut back on calories. Another helpful practice is to eat foods that contain a lot of water, such as vegetables, fruits, and soups.
Children and Diet
Many lifestyle habits begin during childhood. Thus, parents and families should encourage their children to make healthy choices, such as following a healthy diet and doing enough physical activity.
As children are still growing, they may need to follow a special kind of diet to make sure that they are still getting all the nutrients they need to develop healthily. If your child is overweight or obese, consult your doctor before making any significant changes to his or her diet.
Children who are overweight due to a health condition should seek medical guidance.
Research suggests that increasing the amount of exercise is an effective way to lose weight, and the results are even better when combined with changes in diet.
Reduce Sedentary Behaviour
Reduce the amount of time spent being physically inactive, such as, watching television, napping or sitting at a computer.
Increase Lifestyle Activity
Being active doesn’t just mean doing organized exercise. Increasing lifestyle activity is a great way of doing daily exercise, e.g., walking to work or school, climbing stairs, gardening, sweeping the floor, etc.
Then build up slowly to at least 150 minutes of moderate-intensity aerobic activity (i.e., cycling or fast walking) every week. Moderate intensity means that you are breathing slightly more than normal, but you can still comfortably talk as you exercise.
You don’t have to do the activity all at once. You can break it up into short periods of at least 10 minutes each.
When starting a physical activity programme, seek necessary help and supervision to avoid injury. If you’re obese, or if you haven’t been active in the past, start physical activity slowly and build up the intensity a little at a time.
Choose physical activities and sports that you enjoy, as you are more likely to continue doing them. Being physically active and eating fewer calories will help you lose weight and maintain weight loss over time.
Children and Exercise
Children should be encouraged to do at least 60 minutes of moderate activity each day. The activity can be in one session, or several sessions that last 10 minutes, or more. As with children who are overweight, or obese, they may need to do more than 60 minutes of exercise. You should check with your doctor before your child starts a new exercise programme.
Taking medication, under medical advice, for obesity is normally one part of a weight loss programme, and requires a long-term change in lifestyle that includes diet, physical activity, and behavioural changes for lasting results.
SURGERY FOR OBESITY
Weight loss surgery, also called bariatric surgery, has been found to be an effective treatment for some obese people. The National Institute for Health and Clinical Excellence (NICE) recommends that weight loss surgery should only be offered if all the following conditions apply:
- You have a BMI of 40 or more, or you have a BMI of 35-40 and a serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure.
- You have tried all the appropriate non-surgical methods, such as diet and exercise, but have failed to achieve or maintain a beneficial level of weight loss for at least six months.
- You agree to commit to long-term follow-up treatment after surgery at a specialised obesity service.
- You are fit and healthy enough to withstand the anaesthetic and surgery.
Weight-loss surgery limits the amount of food and liquids the stomach can hold. Lifelong medical follow up is needed after surgery. Your doctor may also recommend a programme both before and after surgery to help you with diet, physical activity, and coping skills.
The key to losing weight and maintaining the weight loss is to continue with the lifestyle changes. Adopt these changes as a new way of life.
- Follow a healthy eating plan. Make healthy food choices.
- Focus on portion size. Watch the portion sizes in fast food.
- Be active. For example, go for a brisk walk, bike or run.
- Reduce screen time. Limit the use of TVs, computers and video games because they reduce time for physical activity.
- Keep track of weight, body mass index (BMI), and waist circumference.
Successful weight-loss treatments include setting goals and making lifestyle changes, such as eating fewer calories and doing physical activity regularly. Medicines and weight-loss surgery also are options for some people if lifestyle changes aren’t enough.